Leading Causes of Death in the US During the COVID-19 Pandemic, March 2020 to October 2021

Abstract

Using national death certificate data for 2020 and provisional data for 2021 from the Centers for Disease Control and Prevention, this cross-sectional study examines the leading causes of death in the US, overall and in various age groups.

In 2020, heart disease and cancer were the leading causes of death in the US, accounting for 1.29 million deaths, followed by COVID-19, accounting for 350 000 deaths.^1,2,3 The pandemic may also have indirectly led to increases in other causes of death, including heart disease, diabetes, Alzheimer disease, and unintentional injuries.^2,4 We examined the leading causes of death in the US, overall and in various age groups, from March 2020 to October 2021.

Methods

We obtained final national death certificate data for 2020 and provisional data for 2021 from the Centers for Disease Control and Prevention (accessed May 5, 2022⁵). We excluded data more recent than October 2021 because they were incomplete. We determined the 5 leading causes of death by year and age group, and compared the period March to December 2020 with the period January to October 2021. Because the data are publicly available, the study did not require institutional review board review.

Results

From March 2020 to October 2021, heart disease (20.1%), cancer (17.5%), COVID-19 (12.2%), accidents (6.2%), and stroke (4.7%) were the most common causes of death in the US. There were 2.875 million deaths in March to December 2020 and 2.855 million deaths in January to October 2021; the 5 leading causes of death were the same in each year. Among those older than 1 year, the number of deaths increased across age groups.

Deaths from cancer, heart disease, and COVID-19 accounted for the largest number of deaths in every group aged 55 years and older (Table, Figure). The leading 3 causes of death in these age groups were the same in 2020 and 2021. Among people aged 85 years and older, COVID-19 was ranked as the second leading cause of death in 2020 (110 000 deaths, 12.8% of deaths), and third in 2021 (69 000, 8.9% of deaths). Among those aged 45 to 54 years, COVID-19 was the fourth leading cause of death in 2020 (17 000 deaths, 10.4% of deaths), following heart disease, cancer, and accidents; in 2021, however, it was the leading cause of death (30 000 deaths, 16.8% of deaths).

Table. Five Leading Causes of Death by Age Group From March to December 2020 and January to October 2021.

March to December 2020							January to October 2021
Age group	Total	Cause 1	Cause 2	Cause 3	Cause 4	Cause 5	Total	Cause 1	Cause 2	Cause 3	Cause 4	Cause 5
<1 y
Cause		Congenital malformations	Low birth weight	SIDS	Accidental deathsa	Pregnancy complications		Congenital malformations	Low birth weight	SIDS	Accidental deathsa	Pregnancy complications
No.	16 000	3400	2600	1100	1000	910	17 000	3300	2400	1100	1100	920
1-4 y
Cause		Accidental deathsa	Congenital malformations	Assault	Cancer	Heart disease		Accidental deathsa	Congenital malformations	Assault	Cancer	Heart disease
No.	2900	1000	300	250	250	90	3100	1100	320	250	240	100
5-14 y
Cause		Accidental deathsa	Cancer	Suicide	Assault	Congenital malformations		Accidental deathsa	Cancer	Suicide	Assault	Congenital malformations
No.	4700	1400	660	490	410	260	4900	1500	670	510	390	280
15-24 y
Cause		Accidental deathsa	Assault	Suicide	Cancer	Heart disease		Accidental deathsa	Assault	Suicide	COVID-19	Cancer
No.	31 000	13 000	5600	5100	1100	730	32 000	13 000	5500	5400	1100	1100
25-34 y
Cause		Accidental deathsa	Suicide	Assault	Heart disease	Cancer		Accidental deathsa	Suicide	Assault	COVID-19	Heart disease
No.	63 000	27 000	7100	6200	3400	3000	69 000	29 000	7400	6300	5000	3500
35-44 y
Cause		Accidental deathsa	Heart disease	Cancer	Suicide	COVID-19		Accidental deathsa	COVID-19	Heart disease	Cancer	Suicide
No.	90 000	27 000	10 000	8900	6100	6100	104 000	30 000	13 000	11 000	9300	6500
45-54 y
Cause		Heart disease	Cancer	Accidental deathsa	COVID-19	Chronic liver disease		COVID-19	Heart disease	Cancer	Accidental deathsa	Chronic liver disease
No.	163 000	29 000	29 000	24 000	17 000	8000	179 000	30 000	29 000	28 000	26 000	8700
55-64 y
Cause		Cancer	Heart disease	COVID-19	Accidental deathsa	CLRD		Cancer	Heart disease	COVID-19	Accidental deathsa	Diabetes
No.	375 000	92 000	74 000	42 000	25 000	15 000	395 000	90 000	74 000	60 000	28 000	15 000
65-74 y
Cause		Cancer	Heart disease	COVID-19	CLRD	Diabetes		Cancer	Heart disease	COVID-19	CLRD	Stroke
No.	574 000	146 000	112 000	76 000	31 000	23 000	597 000	149 000	115 000	85 000	31 000	23 000
75-84 y
Cause		Heart disease	Cancer	COVID-19	CLRD	Stroke		Heart disease	Cancer	COVID-19	CLRD	Stroke
No.	699 000	139 000	136 000	97 000	40 000	36 000	681 000	138 000	136 000	82 000	38 000	37 000
≥85 y
Cause		Heart disease	COVID-19	Cancer	Alzheimer	Stroke		Heart disease	Cancer	COVID-19	Alzheimer	Stroke
No.	857 000	210 000	110 000	85 000	72 000	56 000	774 000	200 000	85 000	69 000	61 000	55 000
Total
Cause		Heart disease	Cancer	COVID-19	Accidental deaths	Stroke		Heart disease	Cancer	COVID-19	Accidental deaths	Stroke
No.	2 875 000	580 000	501 000	351 000	172 000	133 000	2 855 000	571 000	502 000	346 000	185 000	134 000

Abbreviations: CLRD, chronic lower respiratory disease; SIDS, sudden infant death syndrome.

^a Accidental deaths include transportation accidents, drug overdoses, alcohol-related deaths, and other accidental deaths.

Figure. Leading Causes of Death in the US, March to December 2020 and January to October 2021.

Bars indicate the number of deaths for each of the 5 most common causes of death by age group for those aged 25 to 34 years, 45 to 54 years, 65 to 74 years, and those aged 85 years and older. Colors are consistent by cause across age groups; however, scales differ. COVID-19 indicates coronavirus disease 2019; CLRD: chronic lower respiratory disease.

In both time periods, accidents accounted for the largest number of deaths in every age group 1 to 44 years. Compared with 2020, COVID-19 increased from the fifth (6100 deaths) to the second leading cause of death (13 000 deaths) among those aged 35 to 44 years in 2021, became the fourth leading cause of death in 2021 among those aged 25 to 34 years (5000 deaths), and those aged 15 to 24 years (1100 deaths).

Discussion

From March 2020 to October 2021, COVID-19 accounted for 1 in 8 deaths in the US and was a top 5 cause of death in every age group aged 15 years and older. Cancer and heart disease deaths exceeded COVID-19 deaths overall and in most age groups, whereas accidents were the leading cause of death among those aged 1 to 44 years. Compared with the 2020 time period, deaths from COVID-19 in the 2021 time period decreased in ranking among those aged 85 years or older but increased in ranking among those aged 15 to 54 years, and became the leading cause of death among those aged 45 to 54 years.

The increased ranking of COVID-19 as a leading cause of death in some age groups is consistent with a downward age shift in the distribution of COVID-19 deaths in the US in 2021 compared with 2020,⁶ perhaps driven by higher COVID-19 vaccination rates in 2021 in the oldest age groups.

The pandemic also has had indirect effects on other causes of death in the US. From 2019 to 2020, death rates increased for heart disease, accidents, stroke, Alzheimer disease, and diabetes.² Potential explanations are fear of accessing health care or misattribution of COVID-19 deaths to other causes.⁴ Accidental deaths (including drug overdoses and unintentional alcohol poisoning), assault, and suicide remain major causes of death in the US, particularly in younger age groups; the pandemic may have contributed to some of these deaths.

Our analysis was limited by potential misclassification of the cause of death and incomplete death data for 2021, although we included a lag of 6 months to increase the completeness of the provisional data. Moreover, because our analysis only extended through October 2021, it does not include deaths that occurred during the Omicron wave of the pandemic of late 2021 and early 2022.